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City of Newport Beach Fire Permit Application
1
Project Address15/0
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Number and Street suite/unit zip
Associated Building Permit# 0 c' OG15
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Owner / Tenant
Name
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3 Scope ofwork/
misc. description
New
Construction TI Addition Alteration Demolition
Check one
Commercial Fi,e Sprinkler
Number of Stories
N r of Heads per building
1• R M
Multi -Family (3+units) M Fire Alarm
r—'lVumber of Devices Q Number of
Dwelling Units
Residential (1-2 units) Fire Underground
Number of Risers
*Check one rj Fire Misc.
*Write in accurate count
*describe above
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4 Applicant Information Name:(SU���(lF%C.�
Address: ,2L/�l V
Phone#: / / Email:
0Check ifs as Contractor
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Designer Information Name: 4' � .--
Address:' ti L '
Phone#: ')/ Jd7l! Email:
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0 Check if s e as Contractor el
Contractor Information Name: X N6 brc
Address: 6Mq r,—
Phone#/ -�yi 61.11 Email
License#: TZ 3 cl I Class: L '
Office Use
Permit Plan Check Permit /Plan
Number Number Check Fee $
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